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Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Well, here's why this remained undiagnosed for so long:

http://news.sciencemag.org/scienceinsider/2012/07/cambodian-killer-unmasked.html?ref=hp

[snip]

Neighboring Vietnam has been badly hit by hand, foot, and mouth disease, so "we were expecting an outbreak sooner or later," Buchy says. But samples from victims did not initially test positive for Enterovirus 71. It was only after contacting scientists at the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam, that the Pasteur team learned that the primers and probes they had designed for the virus in 2009 were out of date. Sequences of more recent Enterovirus 71 strains from Vietnam revealed that the virus had undergone significant genetic drift, Buchy says.

If Enterovirus 71 is indeed the culprit, one puzzling aspect may be the high number of fatal cases in a country of only 15 million people. Vietnam, which has a population roughly six times as large, confirmed only 20 deaths from hand, foot, and mouth disease between January and April of this year. In China, meanwhile, the health ministry announced last week that 240 people died of hand, foot, and mouth disease between January and May 2012. (The death toll has been higher this year than in years past, a ministry official told China Daily.)

While health officials have no idea how many people might be infected with hand, foot, and mouth disease in Cambodia, Buchy speculates that the population is largely naive to the virus and that "we may have a huge proportion of the child population that is not totally immune." Institut Pasteur scientists are now testing additional samples from the 24 patients and waiting for cell culture results. They will then start sequencing the Cambodian strain, Buchy says. Eventually, he says, they hope to determine "for how long and at which level the virus has been circulating" in Cambodia.
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

[]Indonesia heightens monitoring on Cambodian mysterious disease

English.news.cn

July 9 (Xinhua) -- Indonesian Health Ministry is put under a heightened state of vigilance to monitor the recent development of a mysterious disease that reportedly has killed more than 50 children in Cambodia since April, local media reported on Monday.The Health Ministry's director general for disease control and environmental health, Tjandra Yoga Aditama, said that his ministry had been corresponding with the World Health Organization (WHO) and the Cambodian Health Ministry to gather information about the disease's symptoms, and determine whether or not the disease might spread to other countries.
"Currently, the Cambodian Health Ministry and the WHO have yet to collect all the data. Therefore, we can only refer to the disease as an undiagnosed syndrome and a neuro-respiratory syndrome," Tjandra was quoted as saying by the Antara news agency...Even though the disease has claimed dozens of lives, the WHO has yet to issue a travel warning for Cambodia.http://news.xinhuanet.com/english/world/2012-07/09/c_131704362.htm
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

EV-71 virus can result in brain swelling and death ? Cambodian deaths tied to common child illness
PHNOM PENH: Mean Thida, 4, affected with mystery disease, sleeps beside her mother as she receives treatment via a bottle of serum, not in photo, at their home near a dump site at Sambour village, on the outskirts of Phnom Penh, Cambodia, yesterday. A deadly form of a common childhood illness has been linked to many of the mysterious child deaths in Cambodia that caused alarm after a cause could not immediately be determined, health officials said yesterday.? AP

:tiphat:http://news.kuwaittimes.net/2012/07...ambodian-deaths-tied-to-common-child-illness/
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

... They found strains of Streptococcus in throat samples from a number of patients but eliminated it as the cause of death after finding the same strains in samples from children with other symptoms.

Neighboring Vietnam has been badly hit by hand, foot, and mouth disease, so "we were expecting an outbreak sooner or later," Buchy says. But samples from victims did not initially test positive for Enterovirus 71. It was only after contacting scientists at the Oxford University Clinical Research Unit in Ho Chi Minh City, Vietnam, that the Pasteur team learned that the primers and probes they had designed for the virus in 2009 were out of date. Sequences of more recent Enterovirus 71 strains from Vietnam revealed that the virus had undergone significant genetic drift, Buchy says.

If Enterovirus 71 is indeed the culprit, one puzzling aspect may be the high number of fatal cases in a country of only 15 million people. Vietnam, which has a population roughly six times as large, confirmed only 20 deaths from hand, foot, and mouth disease between January and April of this year. In China, meanwhile, the health ministry announced last week that 240 people died of hand, foot, and mouth disease between January and May 2012.(The death toll has been higher this year than in years past, a ministry official told China Daily.)
While health officials have no idea how many people might be infected with hand, foot, and mouth disease in Cambodia, Buchy speculates that the population is largely naive to the virus and that "we may have a huge proportion of the child population that is not totally immune." Institut Pasteur scientists are now testing additional samples from the 24 patients and waiting for cell culture results. They will then start sequencing the Cambodian strain, Buchy says. Eventually, he says, they hope to determine "for how long and at which level the virus has been circulating" in Cambodia.:tiphat:http://news.sciencemag.org/scienceinsider/2012/07/cambodian-killer-unmasked.html?rss=1
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

..
Vorn Pov


Among the dead was Vorn Pov, whom his father said was 12 years old. In Cambodia, it?s common to add a year when counting ages. Vorn Pov died on June 23, about a week after he first became sick. His father, Khuth Vorn, 53, lives in a wooden thatched roof house next to lush green rice fields in Prey Veng province, southeast of Phnom Penh near the border with Vietnam.


When Vorn Pov first got sick, Khuth Vorn took him to a local clinic, where he stayed for three days. He was transferred to a private clinic in Prey Veng provincial town for four days when his condition worsened, after which he was taken to the Kantha Bopha hospital, Khuth Vorn said. His son arrived at 5 p.m. and was pronounced dead four hours later.


?The doctors said his lungs had burned,? Khuth Vorn said, sitting shirtless at a stone table as half-a-dozen barefooted small children played around him in dirt littered with plastic bags, empty soda bottles and discarded cigarette packages. ?My wife was sobbing. We felt helpless.?


Provincial and district officials visited him yesterday to find out more details about his son?s illness, he said.


Iceberg Effect


?If EV-71 is the explanation, what very likely occurred is a massive outbreak of hand, mouth and foot disease, which might not have hit the radar because it?s generally a mild disease and lasts for a few days,? said Peiris.


Peiris explained that in epidemiology there is what is called the iceberg effect: where only a small percentage of the affected present as a serious disease. ?What is different could be the host?s ability to combat the disease,? he said.


Hand, foot and mouth disease is a common infectious disease in infants and children, according to the joint release. It is spread from person to person by direct contact with nose or throat discharges, saliva, fluid from blisters, or the feces of the infected, according to the release. :tiphat:http://ki-media.blogspot.com/2012/07/cambodias-outbreak-linked-to-hand-foot.html#more
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

That last one is an amazing find, Treyfish, and likely indicates that child is the "11-year-old" referred to in the WHO release. While he did die within four hours of hospitalization, the total time from onset to death appears to be at least 7 or 8 days, as he spent three days in the local clinic, and four days in Prey Veng.
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Tonight on AC360: Mystery illness kills children in Cambodia

An illness that quickly turns deadly is claiming the lives of young patients in Cambodia. Doctors at the Kantha Bopha Children's Hospital who regularly treat conditions like Dengue fever, malaria and tuberculosis say they've never seen anything like it.
A World Health Organization representative says many of the children died within 24 hours of being admitted to the hospital. The sickness begins with a mild fever and then rapidly impairs the body. The speed of deterioration and other symptoms are baffling to medical experts.
An enterovirus associated with hand foot and mouth disease has been linked to some of the patients, but that's only one small clue and doctors aren't sure what it means. While parents try to maintain hope, medical experts are working to uncover a pattern and find more pieces to the puzzle.
CNN's Dr. Sanjay Gupta traveled to Cambodia and was granted access to the intensive care unit. Watch his report to learn more at 8 and 10 p.m ET on AC360. :tiphat:http://ac360.blogs.cnn.com/2012/07/09/tonight-on-ac360-mystery-illness-kills-children-in-cambodia/
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

This is a picture from the CNN crew of a child in the Kantha Bopha hospital with encephalitis:

http://instagram.com/p/M27LuCBKOV/

The comments on the right side of the page seem to come from a CNN producer.

Looks like I'm going to be watching CNN in about an hour and a half.

-------------

Dr. Gupta has also released as series of tweets:

http://twitter.com/sanjayguptacnn

Dr. Sanjay Gupta ‏@sanjayguptaCNN
on the streets of phnom penh. need kid sized helmets here. look at the middle of the picture. http://twitpic.com/a5t3cc

8h Dr. Sanjay Gupta ‏@sanjayguptaCNN
RT @DanielleCNN: drs unsure if baby has mystery illness but has encephalitis. http://instagr.am/p/M27LuCBKOV/ inside the hospital tonite on @ac360

10h Dr. Sanjay Gupta ‏@sanjayguptaCNN
at 830a will discuss latest on mysterious disease in cambodia. a virus, EV 71, has been isolated - but many questions remain. @startingptcnn

18h Dr. Sanjay Gupta ‏@sanjayguptaCNN
in ‪#cambodia‬ investigating the mystery illness. at kantha bopha hospital, doctors say "children develop total destruction of the lungs."

8 Jul Dr. Sanjay Gupta ‏@sanjayguptaCNN
just arrived in ‪#cambodia‬ w/ @daniellecnn. investigating mystery illness killing many children. clues emerging, but still much unknown

---------------------

http://fisheggtree.blogspot.com/2012/07/is-cambodias-ev71-outbreak-already-over.html

This week an outbreak of EV71--allegedly a new strain of the virus which causes Hand, Foot and Mouth Disease, was announced here in Phnom Penh. The virus apparently kills most children who catch it, within just 24hrs of being checked into local hospitals. But is this a brand new, mysterious pandemic, with no known cure, set to wipe out children across the world? Or is this merely the latest chapter in the epidemic that has gone on in neighboring Vietnam for more than a year, with relatively few fatalities compared to other more common illnesses like Dengue and Malaria? Dr. Beat Richner of Kantha Bopha hospitals thinks WHO has hyped the illness, but now that foreign journalists are flocking to Cambodia, we'll be hearing about EV71 all-day and every-day whether it is really news or not...
 
Last edited:
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

http://www.cidrap.umn.edu/cidrap/content/other/news/jul0912cambodia-br.html



Enterovirus 71 cited in puzzling Cambodian infections
Lisa Schnirring Staff Writer


Jul 9, 2012 (CIDRAP New) ? Lab analysis in the mysterious recent illnesses and deaths of dozens of Cambodian children pointed to enterovirus 71 (EV-71), a virus that causes hand, foot, and mouth disease (HFMD) and can lead to severe complications in some patients, the World Health Organization (WHO) announced today

Cambodia's health ministry is finalizing its review of all suspected hospitalized cases, which included two additional cases, raising the total to 59 infections, 52 of them fatal, according to the WHO. However, hospital sources said the number of children with severe infections is somewhat higher.

Dr Beat Richner, founder and head of Kantha Bopha Children's Hospitals, which has five facilities in Cambodia, said yesterday in a statement that 66 children have been admitted to the hospitals with the same symptoms and clinical findings, and only two patients have survived.

The WHO and local health officials are exploring other factors that might be contributing to the serious and fatal complications in some of the patients. The WHO said lab tests conducted by Cambodia's Pasteur Institute have turned up other pathogens, including dengue virus and Streptococcus suis. Tests have ruled out H5N1 and other influenza viruses, SARS (severe acute respiratory syndrome), and Nipah virus.

The Pasteur Institute tested 24 samples, and EV-71 was found in 15 of them, according to a report today from the Phnom Penh Post.

Richner said the children suffered from encephalitis, with the condition progressing to total destruction of lung alveoli during the last hours of the children's lives. He said in the statement that he and his team wrote a letter to the health ministry on Jun 20 describing the clinical picture of the cases and suggested that the condition might be caused by an enterovirus infection, intoxication from a medication given before hospitalization, or both. He said all 64 of the children who died at Kantha Bopha hospitals had been previously treated at outside private clinics.

The WHO, the Pasteur Institute, and the US Centers for Disease Control and Prevention (CDC), are assisting Cambodia's health ministry with the outbreak investigation.

H.E. Mam BunHeng, the country's health minister, said yesterday in a joint statement with the WHO, "Further investigation is ongoing and this includes the matching of the laboratory and epidemiological information. We hope to be able to conclude our investigation in the coming days."

The WHO said the patients' ages patients range from 3 months to 11 years, with most younger than 3 years. The male-to-female ratio is 1.3 to 1.

Richner, in his statement, said a Jul 2 WHO statement to Reuters about Cambodia's undiagnosed illnesses caused "unnecessary panic in Cambodia." He added that from a public health perspective, the number of children hospitalized with the infections is not high. He said the five Kantha Bopha hospitals cover 85% of all Cambodian sick children. For comparison, he said, in June 75,779 children were treated in outpatient clinics for dengue infections, 16,517 were hospitalized with severe illnesses, and 5,534 had the most severe form, dengue hemorrhagic fever. Richner added that only 34 children with the supposedly "new" disease were hospitalized in June.

WHO country director Pieter Van Maaren told the Post that the strain had not been easy to diagnose, and that there is no immediate need for a travel advisory.

Van Maaren rejected Richner's claim that the WHO created undue panic about the disease, CNN reported today. He said Richner reported in a letter to the Cambodian health ministry that the situation was "most severe." Also, Van Maaren said that the WHO hasn't made any statements about the disease except for the joint statement it issued with the health ministry.

He told CNN that Cambodia's health ministry reported the outbreak to the WHO in accord with the International Health Regulations and that the WHO was required to communicate the information to other member states.

HFMD, which most frequently strikes children younger than 10, is usually caused by coxsackievirus A16, which produces a mild self-limiting disease that causes few complications, according to the WHO. Enteroviruses, including EV-71, can also cause HFMD that is more serious in certain groups and can be deadly. The period from infection to symptom onset is 3 to 7 days.

The CDC said that since 1997 large outbreaks of HFMD caused by EV-71 have been reported, mostly in children in East and Southeast Asia. Most children have a mild illness and recover without complications, though a small number have severe infections that can be fatal. The agency said research is underway to explore why the outbreaks occur and why the disease is so severe in some patients.

The disease typically begins with fever, poor appetite, malaise, and sore throat. A day or two after fever begins, painful sores develop in the mouth, with a non-itchy skin rash that develops over the next 1 or 2 days on the palms of the hands, soles of the feet, and sometimes on the buttocks or genitals.

The disease spreads from person to person by direct contact with a sick patient's nose or throat secretions, saliva, fluid from blisters, and stool.

There is no specific treatment for HFMD. The WHO said patients with HFMD should drink plenty of fluids and seek treatment for symptoms. It urged health providers to treat patients according to their symptoms and avoid prescribing steroids.

Dr Nima Asgari, who is heading the WHO's investigation efforts, said blistering was reported in only some of Cambodia's cases and that it's possible that steroids administered by doctors masked the symptoms or that the symptoms may not have been recorded, the Associated Press (AP) reported today.

See also:

Jul 9 WHO press release

Jul 8 WHO and Cambodian health ministry joint statement

Jul 8 statement from Dr Beat Richner

Jul 9 Phnom Penh Post story

Jul 9 CNN story

CDC HMFD background

Jul 9 AP story
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Jabs hope after deaths

<!-- An experimental vaccine for Enterovirus 71 - linked to the mystery disease that has killed 52 children in Cambodia since April - is undergoing clinical trials in the mainland and Taiwan.

//-->
Tuesday, July 10, 2012

An experimental vaccine for Enterovirus 71 - linked to the mystery disease that has killed 52 children in Cambodia since April - is undergoing clinical trials in the mainland and Taiwan.

The vaccine is likely to be on the market sooner than any drugs, said virology professor Malik Peiris at the University of Hong Kong School of Public Health.
The Cambodian Ministry of Health and the World Health Organization announced yesterday in Phnom Penh that laboratory results of all hospitalized cases from April to last Thursday revealed "a significant portion of the samples tested positive for EV71, which causes hand, foot and mouth disease."
<TABLE border=0 cellSpacing=0 cellPadding=9 width=250 align=right valign="top"><TBODY><TR><TD><CENTER>
lg.php

<NOSCRIPT></NOSCRIPT></CENTER></TD></TR></TBODY></TABLE>The children range from three months to 11 years old, with a 1.3:1 male to female ratio.
Hong Kong's Centre for Health Protection has told doctors to remain vigilant of "febrile patients returning from Cambodia with respiratory and/or neurological symptoms."
Peiris said the virus does not have to be some "new mutant strain because we know EV71 can cause this type of problem." In 1998, about 200 children died during an outbreak in Taiwan, he said.
Sufferers develop brain stem encephalitis and respiratory distress within hours. Meanwhile, 15 Hongkongers, among a 32-member tour group to Cambodia last month, have been diagnosed with bacterial dysentery after complaining of fever, diarrhea and vomiting. :tiphat:http://www.thestandard.com.hk/news_...7&sid=36977414&con_type=1&d_str=20120710&fc=2
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Well, I watched the show. Not much new from Sanjay Gupta's report that wasn't mentioned elsewhere in this thread. He had video of the Kantha Bopha hospital lobby, which appeared very crowded. He said that they treat over 4,000 patients a week. He did show a clip of a child with encephalitis so bad that his forehead was bulging. He also interviewed Dr. Richner, who says he thinks that EV71 is not, in his experience, a sufficient explanation for the respiratory failure. He also interviewed an expert from the WHO, who say they are looking to see if steroids that were errantly adminstered to some cases may have caused worsening disease.

Anderson Cooper also made the error of referring to EV71 as "Foot and Mouth Disease", which of course is not the same as HFMD.
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Disease Outbreak Has Killed More Than 50 Children Since April, Officials Say
Monday, 09 July 2012
..According to lab results, Enterorvirus 71, which can cause hand, foot and mouth disease, or HFMD, has been identified as the cause of death for a “significant proportion” of those tested, according to officials from the Ministry of Health and the World Health Organization.
Health Minister Mam Bunheng said in a statement more investigation was ongoing.
Sok Touch, director of the communicable disease program at the Ministry of Health, said officials still do not know what caused the outbreak.
Health officials say more study is needed for the results to be conclusive.
Fever, poor appetite, malaise and sore throat are all symptoms of the disease. Within a day or two after onset of fever, painful sores develop in the mouth that can turn into ulcers.
“A person with HFMD may not have symptoms, or may have only the rash or only mouth ulcers,” the Ministry of Health said in a statement.
“HFMD virus is contagious and infection is spread from person to person by direct contact with nose or throat discharge, saliva, fluid from blisters, or the stool or infected persons. Infected persons are most contiguous during the first week of the illness, but the period of communicability can last for several weeks. HFMD is not transmitted from pets or other animals.” :tiphat: http://www.voanews.com/khmer-englis...dren-Since-April-Officials-Say-161820415.html
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Well, that's new. I've never seen a report of S. suis before from Cambodia. Could this be the contaminant Dr. Richner is looking for?

http://edition.cnn.com/2012/07/09/world/asia/cambodia-children-disease/index.html

[snip]

The WHO said that other pathogens had been detected in the investigations, including dengue and Streptococcus suis. It added that samples tested negative for H5N1 and other influenza viruses.

I think that is a good question about S. suis. I'm surprised there isn't more interest in this. This article about S. suis infections in Vietnam says that the infection is thought to be extremely rare in children, yet there have apparently been multiple cases found in this cluster of fatal illnesses in primarily children age 3 and younger. S. suis is thought to be a zoonosis spreading from contact with infected pigs or raw pig products.

All the countries where these episodes of atypical EV71 cluster occur are countries where there is widespread raw pork consumption. I hope they look at a possible co-infection mechanism.

Maybe S. suis facilitiates EV71's entry into the brain:

http://onlinelibrary.wiley.com/doi/10.1016/j.femsim.2004.12.006/full
In summary, this study presents evidence that S. suis disrupts epithelial barrier function in PCPEC monolayers. This disruption is time-, concentration- and strain-dependent and seems to be mediated by two kinds of mechanisms: (1) direct bacteria?host cell interaction and (2) soluble virulence factors. Thus, S. suis may facilitate trafficking of bacteria and leucocytes across the blood?CSF barrier. Further studies will be needed to identify and characterise the molecule(s) responsible for pathogenicity of S. suis serotype 2 in the choroid plexus epithelium and study their mechanism of PCPEC barrier disruption.
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Parents face anxious wait over Cambodia's mystery illness

Phnom Penh, Cambodia (CNN) -- Before dawn, the line of parents trying to comfort their sick children stretched around the Kantha Bopha Children's Hospital in Cambodia's capital, Phnom Penh.

Dozens of children waited their turn for treatment. It is the normal daily routine here, especially during the rainy season when mosquito-borne illnesses are most prevalent.

But over the past four months doctors inside the busy hospital have been faced with something that is not routine at all; a mysterious syndrome killing children so fast nearly all of the children infected with it die within a day or two of being admitted to the hospital.

Other hospitals in the country also began reporting similar cases -- though far fewer than the children's hospital in the capital, which is the most popular. Since April, doctors at the Kantha Bopha hospital have reported 66 cases of the illness. Of those cases only two children survived, while 64 died.

...


http://edition.cnn.com/2012/07/09/world/asia/cambodia-mystery-illness-sidner/index.html
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Well, I watched the show. Not much new from Sanjay Gupta's report that wasn't mentioned elsewhere in this thread. He had video of the Kantha Bopha hospital lobby, which appeared very crowded. He said that they treat over 4,000 patients a week. He did show a clip of a child with encephalitis so bad that his forehead was bulging. He also interviewed Dr. Richner, who says he thinks that EV71 is not, in his experience, a sufficient explanation for the respiratory failure. He also interviewed an expert from the WHO, who say they are looking to see if steroids that were errantly adminstered to some cases may have caused worsening disease.

Anderson Cooper also made the error of referring to EV71 as "Foot and Mouth Disease", which of course is not the same as HFMD.

From post #79:

http://www.flutrackers.com/forum/showpost.php?p=459857&postcount=79

(...)

Enteroviral infection is a serious health problem in the newborn infant.

Approximately 60-70% of infants diagnosed with enteroviral disease within the first 10 days of life acquire their infection by transmission from the mother at the time of delivery.

Congenital infection is rare but often fatal.

Perinatal transmission of enteroviral infections in newborn nurseries has also been implicated as an important route of spread of the disease in newborn infants and postnatal transmission of enteroviral infections during seasonal peaks of enterovirus activity occurs commonly.

Thus, during periods of high prevalence of enterovirus infection in the community, there are many potential sources of infection both during and after discharge from the nursery, including the mother, other family members, and hospital staff.

Approximately 75% of cases of neonatal enteroviral disease carry a benign outcome, with diagnosis and symptomatic treatment in non-intensive care unit settings.

For the remainder of patients, more serious consequences can result from systemic enteroviral infection, including meningoencephalitis, cardiovascular collapse, myocarditis, or hepatitis.

These last two organ-specific complications carry high mortality rates.

Historically, symptom management and supportive care have been the rule in the management of these patients.

No specific therapeutic intervention is currently available for the management of these gravely ill neonates.

The current study will evaluate the antiviral drug pleconaril as a treatment for enterovial sepsis syndrome. This trial is a multi-center, randomized, placebo-controlled study to evaluate the virologic efficacy, safety, and pharmacokinetics of pleconaril in the treatment of severe enteroviral sepsis syndrome.

Patients will be randomized 2:1 to drug or placebo. For enrollment into this trial, infants must have evidence of severe hepatic involvement, myocardial involvement, and/or consumptive coagulopathy.

Their age must be 15 days or less at the time of the onset of disease symptoms. Enrollment will continue until 45 subjects with confirmed enteroviral disease have been enrolled. The primary objective of this investigation is to determine if administration of pleconaril to critically ill neonates with enteroviral sepsis syndrome results in more rapid clearance of virus from various body sites. Other objectives of this study are to assess the safety and pharmacokinetics of this drug in this patient population.

The effects of pleconaril on measures of clinical outcome also will be evaluated. These include the degree of inotropic and blood product support required during the acute illness; duration of hospitalization; the time to resolution of residual organ injury; and short-term (at 2 months of age) and long-term (at 1 year of age) survival. The primary endpoint will be the percentage of patients shedding virus (as detected by viral culture) from the oropharynx (i.e. throat) 5 days after beginning study drug.

The secondary endpoints will include: duration (in days) of shedding of virus (as detected by viral culture) from the oropharynx, rectum, urine, and serum; change in baseline laboratory abnormalities [aspartate aminotransferase (AST), alanine aminotransferase (ALT), bilirubin, platelets, creatinine), reflecting either resolution or progression of enteroviral disease; pleconaril pharmacokinetics; safety; duration (in days) of total hospitalization; survival at 2 months of age; time (in days) to resolution of residual organ-related abnormalities following acute disease; and survival at 1 year of age.

(...)

-
-----
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Intersting find, IOH, but I believe yesterday's WHO report lists the youngest cases in this outbreak as being three months old, so neonatal infection as described above seem less likely.
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Cause of lethal children's disease still contested
<DL class="article-info clearfix"><DD class=create>Tuesday, 10 July 2012</DD><DD class=createdby>Xiaoqing Pi</DD></DL>
http://www.google.com/buzz/post


120710_02a.jpg

A Cambodian woman (L) pulling a child on a gurney at Kantha Bopha children's hospital in Phnom Penh. Medical experts are scrambling to respond to what the Cambodian health ministry and World Health Organization have labelled an "undiagnosed syndrome" that has claimed the lives of at least 56 boys and girls, mostly toddlers, since April. Photograph: AFP Photo / Khem Sovannara

While virologists may have identified a common infection in the mystery illness that has taken the lives of dozens of Cambodian children since April, the actual cause of the deaths is still a matter of conjecture.

The two sides racing to find the cause of the deaths and a possible cure for the illness that has plagued the Kingdom are at odds over almost everything to do with the case.

Kantha Bopha Children?s Hospitals, which first identified that an unusual syndrome was striking down children, alerted the Ministry of Health in June of their concerns about a possible ?new deadly illness?.

Kantha Bopha says it has identified 66 cases of the mystery illness in its hospitals, 64 of the cases were fatal.

However, the Ministry of Health and the World Health Organization, which is assisting the ministry?s investigations, yesterday put the number at 59 cases with 52 deaths across Cambodia ? a pared down number from the initial media reports from the WHO of 60 deaths.

A joint press release from the MoH and the WHO said that their investigations were not finalised, but officials believed that the deaths were caused by severe cases of Hand, Foot and Mouth Disease, a common disease in children and infants.

Symptoms of the HFMD include fever, painful sores in the mouth and a rash with blisters on hands, feet and buttocks, said the press release.

The unknown disease, however, presents the symptoms of deadly respiratory destruction and neurological affliction, as both Kantha Bopha and the MoH and WHO have reported.

Kantha Bopha officials yesterday said they remained suspicious of the information published by MoH and WHO.

Dr Denis Laurent, assistant to Kantha Bopha Hospitals founder Dr Beat Richner, said yesterday that 64 children died of the disease in their hospitals alone.

?It?s up to you to choose,? said Dr Laurent of the discrepancy in numbers. ?You can believe in the MoH, or you can believe in us.?


Richner remained concerned that the children?s deaths were caused by maltreatment and drug intoxication in private clinics.:tiphat:http://www.phnompenhpost.com/index....lethal-childrens-disease-still-contested.html
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

'Cambodian infection is encephalitis type, not HFMD'
07/10/2012 6:06 PM
MANILA, Philippines - The World Health Organization (WHO) and the Department of Health (DOH) reported today that the disease that struck and killed Cambodian children in the last few months was of the encephalitis type and not the hand foot and mouth disease (HFMD) they earlier reported.
The health agencies maintained, however, that the new strain discovered is linked to the Enterovirus-71 (EV-71), which causes different diseases of varying intensities.
EV-71 may also cause HFMD as well as acute respiratory disease, acute flaccid paralysis (polio-like), and the deadly brainstem encephalitis...
...It also urged parents and day-care personnel to clean and disinfect toys and teaching tools that are easily shared with other children.
http://www.abs-cbnnews.com/nation/07/10/12/cambodian-infection-
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

<LI class=dateStamp>WHO Defends Warning on Cambodia Virus <LI class=dateStamp>Updated July 10, 2012, 6:37 a.m. <LI class=dateStamp><LI class=dateStamp>As Cambodian authorities grapple with a disease outbreak that has killed more than 50 children, they're also struggling with another issue: how to best manage interest from the outside world without triggering alarm. The issue bubbled to the surface earlier this week when Beat Richner, a well-known doctor in Cambodia and founder of the Kantha Bopha Children's Hospitals where the disease was first reported, complained that international health authorities moved too quickly to sound the alarm, risking a panic before they had all the facts.
Writing in a post on his Facebook page, he said the World Health Organization's declaration ... The rest is subscription:tiphat:http://online.wsj.com/article/SB10001424052702303567704577518312828428088.html
 
Re: Cambodia - 74 pediatric cases of unknown disease- - 56 deaths - fever, respiratory and neurological symptoms - Enterovirus EV71 identified

Philippines-Doctors, health care providers told to report Enterovirus 71 cases
July 10, 2012 5:48pm

The Health Department will require doctors and health care providers to report incidents of Enterovirus 71 infections by making it a notifiable disease.

A notifiable disease is a disease that must be reported to public health authorities at the time it is diagnosed because it is potentially dangerous to human or animal health...

The DOH said EV-71 causes diseases of varying intensity, including the often mild hand, foot and mouth disease (HFMD), acute respiratory disease, acute flaccid paralysis (polio-like) and the deadly brainstem encephalitis.

It said HFMD is a self-limiting illness whose symptoms include fever with skin lesions or rashes.

Philippine authorities last weekend went on alert against what was then a mystery disease, amid reports of children in Cambodia dying from it.

Also, the DOH and World Health Organization (WHO) clarified the Cambodian EV-71 infection was of the encephalitis type and not HFMD.

The DOH said affected Cambodian children had fever followed by rapid respiratory deterioration and impaired consciousness.

"Death occurred 24 hours from hospital confinement," the DOH said :tiphat:http://www.gmanetwork.com/news/stor...providers-told-to-report-enterovirus-71-cases
 
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